What Is Rosacea

Rosacea (pronounced roh-ZAY-sha) is a common but poorly understood disorder of the facial skin that is estimated to affect well over 16 million Americans -- and most of them don't know it. In fact, while rosacea is becoming increasingly widespread as the populous baby boom generation enters the most susceptible ages, a Gallup survey found that 78 percent of Americans have no knowledge of this condition, including how to recognize it and what to do about it.
Because of its red-faced, acne-like effects on personal appearance, however, it can cause significant psychological, social and occupational problems if left untreated.
While the cause of rosacea is unknown and there is no cure, today medical help is available that can control the signs and symptoms of this potentially life-disruptive disorder. Any one of the following warning signs is a signal to see a dermatologist or other knowledgeable physician for diagnosis and appropriate treatment before the signs and symptoms become increasingly severe:

Redness on the cheeks, nose, chin or forehead.

Small visible blood vessels on the face.

Bumps or pimples on the face.

Watery or irritated eyes.

General

Q. What causes rosacea?A. Although the exact cause of rosacea is unknown, various theories about the disorder's origin have evolved over the years. Facial blood vessels dilate too easily, and the increased blood near the skin surface makes the skin appear red and flushed. Various things -- called trigger factors -- can increase this redness response. Acne-like bumps appear, often in the redder area of the central face. This may be due to factors related to blood flow, skin bacteria, microscopic skin mites (Demodex), irritation of follicles, sun damage of the connective tissue under the skin, an abnormal immune or inflammatory response, or psychological factors.

None of these possibilities has been proven, although potential inflammatory pathways have been identified in recent ongoing research -- including an immune response triggered by a type of antimicrobial protein known as cathelicidin. A recent study also found that certain bacteria present on otherwise harmless Demodex mites could prompt an inflammatory response in rosacea patients.

Q. Is rosacea contagious?A. No. Rosacea is not considered an infectious disease, and there is no evidence that it can be spread by contact with the skin or through inhaling airborne bacteria. The effectiveness of antibiotics against rosacea symptoms is widely believed to be due to their anti-inflammatory effect, rather than their ability to destroy bacteria.

Q. Is rosacea hereditary?A. Although no scientific research has been performed on rosacea and heredity, there is evidence that suggests rosacea may be inherited. Nearly 40 percent of rosacea patients surveyed by the National Rosacea Society said they could name a relative who had similar symptoms.
In addition, there are strong signs that ethnicity is a factor in one's potential to develop rosacea. In a separate survey, 33 percent of respondents reported having at least one parent of Irish heritage, and 26 percent had a parent of English descent. Other ethnic groups with elevated rates of rosacea, compared with the U.S. population as a whole, included individuals of Scandinavian, Scottish, Welsh or eastern European descent.

Q. Can rosacea be diagnosed before you have a major flare-up?A. It is sometimes possible to identify "prerosacea" in teenagers and persons in their early 20s. These individuals generally come to the dermatologist for acne treatment and exhibit flushing and blushing episodes that last longer than normal. The prolonged redness usually appears over the cheeks, chin, nose or forehead. These patients also may find topical acne medications or certain skin-care products irritating.
Once identified, these rosacea-prone individuals can be counseled to avoid aggravating lifestyle and environmental factors known to cause repeated flushing reactions that may lead to full-blown rosacea. If you recognize the symptoms of prerosacea in a younger family member or others, they might be advised to consult a dermatologist.

Q. Is there any kind of test that will tell you if you have rosacea?A. There are no histological, serological or other diagnostic tests for rosacea. A diagnosis of rosacea must come from your physician after a thorough examination of your signs and symptoms and a medical history. During your exam you should explain any problems you are having with your face, such as redness; flushing; the appearance of bumps or pimples; swelling; burning, itching or stinging; or other information.

Q. Will my rosacea get worse with age?A. There is no way to predict for certain how an individual's rosacea will progress, although physicians have observed that the signs and symptoms tend to become increasingly severe without treatment. Moreover, in a National Rosacea Society survey, about half of rosacea sufferers said without treatment their condition had advanced from early to middle stage within a year. Fortunately, compliance with medical therapy and lifestyle modifications to avoid rosacea triggers has been shown to effectively control its signs and symptoms on a long-term basis.

Q. How long does rosacea last?A. Rosacea is a chronic disorder, rather than a short-term condition, and is often characterized by relapses and remissions. A retrospective study of 48 previously diagnosed rosacea patients found that 52 percent still had active rosacea, with an average ongoing duration of 13 years. The remaining 48 percent had cleared, and the average duration of their rosacea had been nine years. While at present there is no cure for rosacea, its symptoms can usually be controlled with medical therapy and lifestyle modifications. Moreover, studies have shown that rosacea patients who continue therapy for the long term are less likely to experience a recurrence of symptoms.

Signs and Symptoms

Q. Does rosacea cause facial swelling, burning or itching?A. Facial burning, stinging and itching are commonly reported by many rosacea patients. Certain rosacea sufferers may also experience some swelling (edema) in the face that may become noticeable as early as the initial stage of the disease. The same flushing that brings on rosacea's redness can be associated with a build-up of fluid in the tissues of the face. It often occurs above the nasolabial folds -- the creases from the nose to each side of the mouth -- and can cause a "baggy cheek" appearance. It is also believed that in some patients this swelling process may contribute to the development of excess tissue on the nose (rhinophyma), causing it to become bulbous and bumpy.

Q. Are rosacea symptoms generally symmetrical or asymmetrical?A. Rosacea can present itself in different ways for different individuals. Rosacea patients may exhibit varying levels of severity of symptoms over different areas of the face. Patients have often reported that the disorder actually began with a red spot or patch on one cheek or another part of the face, and then spread to other areas. On the other hand, many rosacea patients exhibit similar symptoms on both sides of their faces.

Q. I suffer from regular acne in addition to rosacea. Is this common?A. Rosacea and regular acne, called acne vulgaris, usually appear separately, but some patients are affected by both. While both conditions in adults are often informally referred to as "adult acne," they are two separate diseases, each requiring different therapy. Acne vulgaris is associated with plugging of the ducts of the oil glands, resulting in blackheads and pimples on the face and sometimes also the back, shoulders or chest. Rosacea seems to be linked to the vascular network of the central facial skin and causes redness, bumps, pimples and other symptoms that rarely go beyond the face. Special care is necessary in treating patients with both conditions because some standard medications for acne vulgaris can make rosacea worse.

Q. Is dry, flaky skin typical with rosacea?A. It has been estimated that approximately half of all rosacea sufferers may appear to experience dry skin. With treatment, this dryness often eases along with disappearance of papules and pustules. To combat dry, flaky skin, use a moisturizer daily after cleansing and applying medication. You also may wish to check with your dermatologist to see which medication is best for your skin type, since some have a drying effect and others are more moisturizing.

Q. Is oily skin common for rosacea sufferers?A. There is no standard skin type for rosacea patients. Many sufferers experience dry, flaky skin, while others may have normal or oily skin, or both. The key is to identify your skin type and use medication and skin-care products that are suitable for you.

Q. Is there any connection between rosacea and seborrheic dermatitis?A. It is not unusual for seborrheic dermatitis to appear concurrently with rosacea. Seborrhea manifests as reddish-yellow greasy scaling in the central third of the face. Scalp, eyebrows and beard may have fine flakes of white scale, dandruff or patches of thicker, greasy yellow scale. Eruptions may also appear beyond the face.

Q. Is there any connection between ordinary eczema and rosacea?A. No, nothing in the medical literature links rosacea and atopic eczema. The two diseases may share some symptoms, but also have many differences. Rosacea is more common in fair-skinned individuals and nearly always affects the face only, causing such signs and symptoms as redness, visible blood vessels, bumps and pimples and sometimes swelling of the nose from excess tissue. Atopic eczema is more common in individuals with dry skin and can appear in various areas of the body, producing red scaling and crusted or weeping pustules that itch fiercely.

Q. Is there a connection between lupus and rosacea?A. No. Discoid lupus is a chronic, scarring skin disease. Another form, systemic lupus, is characterized by a variety of signs, including some in the vascular system. Because lupus can cause a reddish skin rash that spreads across the bridge of the nose and face, often in a butterfly pattern, it can appear similar to rosacea. However, while both rashes can be smooth in texture, the presence of bumps and pimples, which rarely occur in a lupus flare, may help differentiate the diseases. In addition, lupus is almost always accompanied by other symptoms not associated with rosacea, such as fever, arthritis and signs of renal, lung or heart involvement. A dermatologist can usually quickly tell the difference between a butterfly rash of lupus and rosacea.
Moreover, unlike lupus, as many as 50 percent of rosacea patients may also have ocular signs. Visually, an eye affected by rosacea often appears watery or bloodshot. Sufferers may feel a gritty or foreign body sensation in the eye, or have a dry, burning or stinging sensation.

Q. Are rosacea sufferers more likely to get skin cancer later in life?A. No medical evidence has linked rosacea directly with skin cancer. Rosacea sufferers may be more likely to develop skin cancer later in life because of their frequent light complexions and propensity to injury from ultra-violet radiation from the sun. It is important that you consult your dermatologist if you have any signs of possible skin cancer, such as a mole that is enlarged or asymmetric or that has an irregular border or varying color. Although unrelated to rosacea, skin cancer is a potentially fatal disease whose incidence has been on the rise.

Q. I've been using medication for some time now and it has cleared my pimples and reduced my redness, but it also seems to have made me develop more spider veins. What's going on?A. Visible blood vessels (telangiectasia) sometimes develop with rosacea and were likely always there, but were hidden or less noticeable because of your redness. Once medication has diminished the redness, it is not uncommon for spider veins to become more noticeable. These can be camouflaged with makeup, or removed with a vascular laser, intense pulsed light source or other medical device.

Q. Can you get rosacea on other parts of your body?A. Although it is not a common feature of rosacea, symptoms have been reported to appear beyond the face. In a National Rosacea Society survey, rosacea patients reported experiencing symptoms on the neck, chest, scalp, ears and back.

Q. How does menopause affect rosacea?A. The hot flashes sometimes associated with menopause may bring on a flare-up or even the initial onset of rosacea. A Swedish study also noted that postmenopausal women with rosacea may be more likely to experience migraine headaches.

Q. Can rosacea involve the eyes?A. Yes. Known as ocular rosacea, eye symptoms may include a watery or bloodshot appearance and a dry, gritty feeling with burning, itching and/or stinging. Individuals with rosacea may be prone to styes, and light sensitivity and blurred vision may also be present. Left untreated, decreased visual acuity due to corneal involvement may occur. Eye involvement may appear before as well as after any skin signs or symptoms, and individuals who suspect they may have ocular rosacea should consult a dermatologist or ophthalmologist for appropriate therapy.

Trigger Factors

Q. What are the most common lifestyle and environmental factors that aggravate rosacea or trigger flare-ups?A. Some of the most common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, alcohol, spicy foods, heavy exercise, hot baths, heated beverages and certain skin-care products.

Q. How long after a rosacea trigger will a rosacea flare-up occur?A. Although there are no data available on how quickly a rosacea trigger may lead to a flare-up, the time is likely to vary depending on the individual and the nature of the trigger. Try monitoring your individual case to see how quickly your rosacea has responded. And remember, while a wide range of factors has been identified as potential triggers, not every trigger affects every individual every time.

Q. Is there any relationship between rosacea and allergies?A. Allergies may cause an altered reaction of the body that includes flushing, which frequently triggers rosacea symptoms. As with more common rosacea triggers, identifying and avoiding allergens -- the substances you are reacting to -- may also help control your rosacea.

Q. Will exercise cause my rosacea to flare up?A. Any activity such as exercise that causes flushing or overheats the face has the potential to spark a rosacea flare-up. The good news is that signs and symptoms may be avoided or reduced by managing your workout. Ways to help reduce the incidence of flare-ups include working out in the early morning or late evening when weather is cooler; working out more frequently but for shorter intervals; keeping cool indoors by running a fan or opening a window; and cooling off by keeping a damp towel on your neck, drinking cold fluids or chewing on ice chips. Choosing low-intensity exercise or water aerobics may also be useful.

Treatment

Q. Can rosacea be cured?A. While rosacea cannot be cured, medical treatments are available that can control or eliminate its various signs and symptoms.

Q. How is rosacea treated?A. The signs and symptoms of rosacea vary substantially from one patient to another, and treatment must therefore be tailored by a physician for each individual case. Some patients are troubled by redness and flushing, while others have bumps and pimples, thickening of the skin, or eye rosacea or combinations. For patients with redness and pimples, doctors often prescribe oral antibiotics and topical therapy to bring the condition under immediate control, followed by long-term use of the topical therapy alone to maintain remission.
When appropriate, laser treatment or other surgical procedures may be used to remove visible blood vessels, reduce extensive redness or correct disfigurement of the nose. Eye symptoms are commonly treated with oral antibiotics and ophthalmic therapy.
In addition, rosacea patients are advised to identify and avoid lifestyle and environmental factors that may aggravate their individual conditions. Patients may also benefit from gentle and appropriate skin care, and cosmetics may be used to reduce the effect of rosacea on appearance.

Q. Why are antibiotics prescribed for rosacea? Is it a bacterial infection?A. It is unknown exactly why antibiotics work against rosacea, but it is widely believed that it is due to their anti-inflammatory properties, rather than their bacteria-fighting capabilities.

Q. What about bacterial resistance from antibiotic use?A. Topical antibiotics result in such minimal levels of medication in the bloodstream, if any, that there is virtually no risk of developing bacterial resistance at sites other than where the topical antibiotic is being applied. A version of an oral antibiotic with less risk of microbial resistance has been developed specifically for rosacea.

Q. What medications are used for rosacea besides antibiotics?A. Physicians may use a variety of medications to help control rosacea in individual patients. Products containing a sulfur drug or azelaic acid may be prescribed as an alternative or adjunct to antibiotic therapy, and a cardiovascular medication is sometimes used to control severe flushing. Other medications may also be considered, especially in cases that do not respond to initial therapy.

Q. What about long-term side effects?A. Topical therapy results in such minimal levels of medication in the bloodstream, if any, that there is virtually no risk of systemic side effects except allergic reactions. Possible side effects associated with oral antibiotic therapy include upset stomach, sensitivity to sun exposure, tooth discoloration, diarrhea, allergic reactions and vaginal yeast infections.

Q. If I take long-term medication consistently, will it lose its effectiveness?A. Topical therapy usually controls rosacea on a long-term basis, without loss of effectiveness.

Q. Should I still use my medication between flare-ups?A. Rosacea is characterized by flare-ups and remissions, and a study found that long-term medical therapy significantly increased the rate of remission in rosacea patients. In a six-month multicenter clinical study, 42 percent of those not using medication had relapsed, compared to 23 percent of those who continued to apply a topical antibiotic. In general, treatment between flare-ups can prevent them.

Q. How should I care for my skin?A. A rosacea facial care routine recommended by many dermatologists starts with a gentle and refreshing cleansing of the face each morning. Sufferers should use a mild soap or cleanser that is not grainy or abrasive, and spread it with their fingertips. A soft pad or washcloth can also be used, but avoid rough washcloths, loofahs, brushes or sponges.
Next, rinse the face with lukewarm water several times and blot it dry with a thick cotton towel. Never pull, tug, scratch or treat the face harshly. Sufferers should let their face air dry for several minutes before applying a topical medication. Let the medication soak in for an additional five or 10 minutes before using any makeup or other skin care products.

Q. What skin-care products are appropriate to use with rosacea?A. The skin of many rosacea sufferers may be sensitive and easily irritated. Patients should avoid using any products that burn, sting or irritate their skin. In a national survey, many individuals with rosacea identified alcohol, witch hazel, fragrance, menthol, peppermint, eucalyptus oil, clove oil and salicylic acid as ingredients that irritated their individual cases, and many also avoided astringents and exfoliating agents. A useful rule of thumb may be to select products that contain no irritating or unnecessary ingredients.
Sunscreens or sunblocks effective against the full spectrum of ultraviolet A and B radiation can be especially important for rosacea patients, whose facial skin may be particularly susceptible to sun damage and consequent rosacea flare-ups. An SPF of 15 or higher is recommended, and physical blocks utilizing zinc or titanium dioxide may be effective if chemical sunscreens cause irritation.

Q. How does laser therapy work?A. To remove visible blood vessels or reduce extensive redness, vascular lasers emit wavelengths of light that target tiny blood vessels just under the skin. Heat from the laser's energy builds in the vessels, causing them to disintegrate. Generally, at least three treatments are required, depending on the severity of redness or visible blood vessels.
Vascular lasers may also be used to help retard the buildup of excess tissue, and in severe cases a CO2 laser may be used to remove unwanted tissue and reshape the nose. New laser technology has been developed to minimize bruising, and recently developed devices called intense pulsed light sources mimic lasers but generate multiple wavelengths to treat a broader spectrum of tissue. As with any surgical technique, the safety and effectiveness of laser therapy may depend on the skill of the physician.

Q. How do I control flushing/blushing?A. As always, the best offense is a good defense. Individuals with rosacea should identify and avoid environmental and lifestyle factors that cause flushing.

Q. Do steroids induce rosacea?

A. While effective in treating certain skin conditions, long-term use of topical steroids may prompt rosacea-like symptoms informally called "steroid-induced rosacea." While some physicians may prescribe a short course of a steroid to immediately reduce severe inflammation, if you are concerned about a medication you are taking, your best bet is to discuss this with your physician.

Facial Cleansing for Rosacea

Gentle cleansing is extremely important for skin with rosacea. Twice-daily cleansing removes excess oil, environmental debris, bacteria and other microorganisms, as well as the residue from skin-care and makeup products. It's the first step in helping to soothe and treat your skin.

Choosing a Cleanser

Choose your cleanser with care according to your skin type. Keep in mind that unless your skin is oily, non-soap cleansers may be the best option — they contain less than 10% soap, rinse off easily, and have a neutral pH that's closer to the natural pH of the skin.

Dry to normal or combination skin. A wide range of non-soap cleansers is available, including a number of options developed specifically for sensitive or redness-prone skin.

Very dry skin. A creamy, low-foaming, non-soap cleanser may be ideal for skin that's very dry — these types of formulas often leave behind a thin film that helps skin hold moisture.

Oily skin. For very oily skin, wash with a mild soap, taking care to avoid scrubbing. Aggressive rubbing or over-cleansing can irritate skin.

Cleansing Tips

To minimize skin irritation, try this gentle, step-by-step cleansing routine developed by leading dermatologists for people with rosacea.

Using your fingertips, wash skin with a cleanser suitable for your skin type. Avoid using an abrasive washcloth or sponge, which may irritate.

Rinse away cleanser with lukewarm water. Hot or cold water may cause flushing or irritation. Gently blot your face dry with a thick-pile cotton towel. Don't rub skin, as this may cause irritation. Spray on a toner.

Since stinging most often occurs on damp skin, wait 30 minutes for the face to dry completely before applying any topical medication. Slowly reduce the drying time until you find the least amount of time your skin needs to avoid a stinging sensation.

After applying topical medication, wait five to 10 minutes more before applying moisturizer, sunscreen or makeup.

If you have ocular rosacea, be sure to follow your doctor's directions for eyelid scrubbing and medication

Sun Protection and Moisturizer

Proper, consistent skin care is an important measure to calm skin with rosacea and help minimize redness and irritation. Daily use of sunscreen is recommended for rosacea patients, and many may also benefit from the use of a moisturizer. Here's what you can do to help take care of your skin.

Moisturizer

Moisturizer is a key for preventing the burning, stinging, itching and irritation often associated with rosacea. It's important to build a strong moisture barrier to help keep out impurities and irritants that may aggravate sensitive skin.
Facial moisturizers have now been developed specifically for signs and symptoms experienced by many people with rosacea. They are specially formulated with ingredients intended to calm and soothe facial skin and to help prevent redness from irritation.

Sunscreen

Daily sun protection is a must for any skin type, but anyone with rosacea should be especially vigilant. Sun exposure was named a top trigger for rosacea flare-ups by 81 percent of patients in a National Rosacea Society survey, and is also linked to the visible blood vessels (telangiectasia) and severe redness often associated with rosacea.

Find the right formula. There are two types of damaging rays: UVA rays age skin, UVB rays burn it. Surprisingly, not all sunscreens protect against both. Look for non-chemical sunscreens that contain zinc or titanium dioxide and deliver UVA/UVB protection with an SPF of 15 or higher. A formula designed for sensitive skin can help reduce the possibility of irritation.

Be smart — wear it every day. Apply sunscreen daily year-round, whether it's sunny or cloudy — the incidental exposure you get in front of a computer monitor, fluorescent lighting, walking to your car or running errands can be just as damaging to skin over time as a day at the beach. There are also UVA/UVB sunscreens available that are designed for redness-prone skin.

For intense sun exposure — a day spent outdoors, at the beach or by the pool — use an ounce of sunscreen (about a shot glass full) to cover the body. Apply it 30 minutes before going outside so it has time to absorb into the skin, and reapply it every two hours after swimming or sweating. Ideally, limit your sun exposure, especially between the hours of 10 a.m. and 4 p.m. when the sun is strongest. And take note: high altitude, snow, water and even eyeglasses can increase the effect of ultraviolet rays, so protect skin throughout the year whenever you're outdoors

Makeup for Rosacea
While medical therapy can address the underlying physical aspects of rosacea, makeup can help instantly improve the look of your skin and boost your self-confidence about your appearance. Here are some tips to help you look and feel your best.

Get a clean start. Before applying makeup, cleanse and moisturize your face with skin-care products appropriate for your skin. Always treat skin gently, never rubbing or pulling with your fingers, makeup sponges or even a washcloth or towel, as this may cause irritation. And use the right tools to minimize irritation — anti-bacterial brushes may be best, since even the oil and bacteria on your fingers can irritate skin.

Keep it simple. The more ingredients and products you apply to your skin, the higher the likelihood that an ingredient or product may aggravate it. That's why it may be helpful to use multi-function products, such as a green-tinted base that also contains sunscreen. Avoid any products that burn, sting or irritate your skin.

Use a green-tinted base. A sheer green-tinted primer is a good choice for a makeup base — it can help visually correct redness and even out skin tone. Get one with UVA/UVB protection and you'll help shield skin from exposure that can aggravate rosacea. A protective base has another bonus, too: it helps your makeup last longer.

Choose oil-free foundation and concealer. Look for an oil-free foundation that offers the level of coverage you need, from sheer to full. And for both foundation and concealer, choose your shade carefully. Foundation should match your natural skin tone as closely as possible, while concealer should be just one shade lighter than your natural skin tone.

How to apply foundation. Use a light touch when applying foundation. You may want to use an antibacterial foundation brush to apply it rather than a sponge (too harsh for skin) or your fingertips (can add unnecessary oil to the face). For brush application, start by applying a small amount of liquid foundation to the back of your hand. Dab with the brush and smooth over your face, starting in the center and blending outward. For cream or powder foundation, sweep the brush across the surface of the compact and apply to your face. Use broad strokes for large areas of the face: cheeks, forehead and chin. Use the edge of the brush to reach narrow areas: nose, mouth, eyes and hairline. Blend well. Be sure to clean the brush between uses.

How to apply concealer. Use an antibacterial concealer brush to lightly dot concealer under your eyes, starting at the inner corner and working outward. Blend well for a seamless look. You can hide bumps or visible blood vessels by dabbing and blending concealer directly onto each area, then using foundation all over to create a more even tone.

Consider cover-corrective makeup. Especially for those with moderate to severe rosacea, cover-corrective cosmetics may be an appropriate option. Available in a choice of formulations with UVA and UVB sun protection and a wide array of tones to match your natural skin color, they can thoroughly conceal many types of skin imperfections to create a flawless look.

Explore the benefits of mineral powder. Mineral makeup is often a good choice for skin with rosacea, as it typically doesn't contain potentially irritating ingredients. There are also innovative mineral powder formulas specifically formulated to color-correct redness. Dust a yellow-toned mineral powder over foundation, or use it over your protective base instead of foundation to help further tone down the look of redness.

To blush or not to blush. Mineral powder blushers are also available, but since skin already tends to have a lot of color, go easy on cheek color if you use it at all. Choose sheer blush formulated for sensitive skin and apply sparingly with an antibacterial brush, sweeping it from the apples of the cheeks toward the temples.

Opt for extra-gentle eye makeup. Eyes are sensitive to begin with, and if yours have signs and symptoms of ocular rosacea, it's especially important to treat the eye-area skin gently. Select products designed for sensitive eyes that have been ophthalmologist tested — and allergy- tested, fragrance-free formulas may be ideal. Mascara and eyeliner should be easy to apply and remove without pulling or tugging on the eyes. Look for mascara formulas that can be gently removed by simply rinsing with warm water. Mineral powder eye shadow may be the perfect choice for eyes susceptible to rosacea symptoms. Neutral colors, both in shadow and eye pencils, may also be less irritating than strong jewel tones since they have less pigment.

Go for neutral lips. Lips will shine in neutral shades close to your natural lip color. Avoid red shades that may exacerbate the look of redness in your skin.